To determine the validity and reliability of the physical examination in evaluating abnormalities of the lower eyelid following blepharoplasty, a model using monkeys was developed. One plastic surgeon performed a variety of blepharoplasties, including extensive resection of lower lid skin and/or muscle, and/or the creation of scarring in the orbital septum. Three months postoperatively, a second plastic surgeon and an ophthalmologist examined these monkeys' lower eyelids. Although there was substantial agreement between the observers as to the degree of scleral show and which eye was 'worse' in each monkey, the examiners were correct in just 7 of 24 attempts to identify the exact operative procedure that had been performed. This study demonstrates that it is difficult to identify the cause of abnormalities in appearance and position of the lower lid after blepharoplasty. Orbital septal scarring can cause the same degree of scleral show as excessive skin resection. Muscle resection contributed little to lower lid position.
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